氢化可的松在肺部感染致感染性休克中应用的前瞻性临床研究  

Initiation of hydrocortisone treatment for pneumonia induced septic shock:a prospective clinical study

作　　者：吕清泉[1] 顾小花[1] 陈齐红[1] 吕应鸣 郑瑞强[1] Lyu Qingquan;Gu Xiaohua;Chen Qihong;Lyu Yingming;Zheng Ruiqiang(Department of Critical Care Medicine,Subei People＇s Hospital of Jiangsu Province,Yangzhou 225000,China;Department of General Surgery,Demei Rehabilitation Hospital,Xinghua 225700,China)

机构地区：[1]江苏省苏北人民医院重症医学科,江苏扬州225000 [2]兴化市德美康复医院普外科,江苏兴化225700

出　　处：《中华重症医学电子杂志》2018年第2期141-146,共6页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家自然科学基金资助项目(81670065);江苏省社会发展重点专项(BE2017691)

摘　　要：目的探讨早期小剂量氢化可的松对肺部感染致感染性休克患者病死率的影响。方法采用前瞻性随机对照临床研究(RCT)方法 ,连续选择2015年9月至2017年2月收住于江苏省苏北人民医院重症监护病房(ICU)的54例肺部感染致感染性休克患者。将患者随机分为氢化可的松组和对照组。两组患者一旦使用血管活性药物,立即同时予以研究药物(氢化可的松或0.9%氯化钠溶液)持续静脉泵入。记录患者28 d病死率、住院病死率、休克逆转率、住ICU及住院时间等,评估早期小剂量氢化可的松的使用对肺部感染致感染性休克患者预后的影响。结果两组患者在28 d病死率、住院病死率、休克逆转率、住ICU时间及住院时间等方面差异均无统计学意义(均P>0.05)。二分类Logistic回归模型分析显示28 d内机械通气时间是肺部感染致感染性休克患者28 d病死率的独立影响因素(OR=0.654,95%CI:0.498～0.860,P=0.002)。而小剂量氢化可的松的应用在Logistic回归模型分析中差异无统计学意义(P>0.05)。结论在肺部感染致感染性休克患者中早期应用小剂量氢化可的松,并不能降低病死率、住ICU时间及住院时间。Objective To assess the effect of early initiation of low dose hydrocortisone on mortality in patients with pneumonia induced septic shock. Methods A prospective randomized controlled trial（RCT） was conducted in Department of Critical Care Medicine of Northern Jiangsu People＇s Hospital.Fifty-four patients with pneumonia induced septic shock from September 2015 to February 2017 were enrolled in this study. Patients were randomly assigned to receive hydrocortisone or 0.9% sodium chloride solution at the same time of the vasopressors were initiated. In this study, 28-day mortality, hospital all-cause mortality, reversal of shock, length of stay in the ICU and hospital were recorded to evaluate the effect of early initiation of low-dose hydrocortisone treatment in patients with pneumonia induced septic shock.Results There were no significant differences in 28-day or hospital all-cause mortality; reversal of shock; length of stay in the ICU or hospital between patients treated with hydrocortisone and placebo（all P〉0.05）. The binary logistic regression model showed that duration of mechanical ventilation up to day 28 was an independent risk factor of 28-day mortality（P〈0.05）. Conclusion The early initiation of low-dose hydrocortisone did not decrease mortality, and the length of stay in the ICU or hospital in adults with pneumonia induced septic shock.

关 键 词：肺部感染 感染性休克 氢化可的松 病死率 

分 类 号：R459.7[医药卫生—急诊医学]